Numbers Not Adding Up for Senate Democrats on Health Care Reform

Anxious Democratic senators are awaiting the scoring by the Congressional Budget Office (CBO) of their latest tweak to the Senate health care reform bill. The new compromise proposal abandons the “public option" but allows individuals aged 55-64 to obtain coverage through Medicare. It also expands the Medicaid program to include adults with incomes up to 150% of the poverty level.

But the real numbers that the Democrats in the Senate have to chew on while they wait matter more to them than whether the latest scoring will add $50 billion or $100 billion to the ten-year cost of the bill. They are the numbers that politicians always follow: presidential approval ratings, congressional approval ratings, polls for the upcoming midterm elections, and polls on the level of support for the health care bill itself. These numbers are falling off a cliff for the president, the Congress, individual Democratic senators and House members facing re-election, and the bill itself.

And they now may place the passage of the bill in jeopardy, regardless of the measures designed to get 60 votes in the Senate or the CBO scoring.

The conventional wisdom is that the Democrats have to pass a bill; they have to find 60 votes in the Senate to pass some multi-trillion dollar concoction or version of “reform." The president has made health care reform the centerpiece of his “change” agenda. The bill, in different forms, passed three committees in the House and two in the Senate. A version has now passed the entire House. The momentum for passage in the Senate is strong.

The Democrats are now closer than they have been since the creation of Medicare and Medicaid during the Johnson years to vastly expanding the government’s health care entitlement programs and cutting the number of uninsured Americans by about two-thirds. If the Senate can get to 60 votes, close off debate, and pass a final bill, it is likely the House will cave and follow the Senate’s lead.

I have been arguing for months that the liberals in both the House and Senate will be the ones who move to appease the moderates in order to get something passed. The House progressives allowed a tough anti-abortion amendment to pass in order to secure the votes needed for final passage of the measure in the House and “kick the ball down the field" hoping they could get rid of this provision at a later date in the process. The moderate Democrats in both the House and the Senate by and large come from swing districts or purple states, while the more ideologically driven progressives hail from safer House districts and bluer states. In order to get a health reform bill passed, the progressives will settle for half or three-fourths of a loaf and protect their less leftist colleagues, giving them a bill they can tolerate, if not warmly endorse, thereby shielding them in future election cycles.

The evidence that Harry Reid’s effort may be cratering can be seen in the few days since the latest compromise package was reached by “the gang of ten Democrats” -- five moderates and five liberals. The senators who are taking to the airwaves to express concern or offer new amendments (allowing importation of drugs from Canada is the latest amendment that is gumming up the works) has expanded beyond the core group of holdouts Harry Reid had been cajoling on the public option -- Joe Lieberman, Ben Nelson, Blanche Lincoln, and Mary Landrieu. Now, Bill Nelson of Florida, Byron Dorgan of North Dakota, and Jim Webb of Virginia are among a larger group who have become skeptics and are suggesting fixes.

The Senate defeated Ben Nelson’s abortion language by 54-45 earlier in the week. If the Democrats get 60 votes to end debate and pass a bill, how many anti-abortion House Democrats who backed the Stupak amendment will support the Senate version of the bill that does not include this language? The House version of the bill with the Stupak amendment passed by only 220-215. One vote -- by Republican Joseph Cao -- only came after the 218 vote level was assured. Polls on the health care bill have gotten much worse since the House vote. Passage of a bill following the Senate model, without the Stupak language and with the Medicare expansion, is by no means assured in the House.

The expansion of Medicare is problematic for many senators and will be for many House members as well. Medicare pays widely varying rates across the country, and if the program is expanded, the lower Medicare fee schedule would replace the higher private pay rates for anyone who becomes part of this coverage group. There have already been estimates that 10-20% of hospitals and providers could face financial difficulty because of the proposed Medicare cuts that are in the bill.

The 55-64 age group have far higher use rates (occasions of service per 1,000) than younger populations. As a result, the shift to a lower Medicare rate schedule would impact a far higher percentage of the caseload for providers than the percentage of the population represented by those covered by the new plan.

It is possible that some of what is now going on is an effort at face saving by senators who in the end will not support the bill. Maine’s two Republican senators -- Olympia Snowe and Susan Collins -- are Harry Reid’s best hope for a vote or two to enable him to sell the reform effort as a bipartisan bill and for insurance if one or more Democrats, or independent Senator Joe Lieberman, bolt. Both have expressed reservations on the new Medicare expansion. The Senate bill would add 15 million enrollees to Medicaid. That is a new and very costly unfunded burden for the states, many of which are in grave financial difficulty already and don't have the luxury of the federal government to print money and run up enormous annual deficits ($1.4 trillion for fiscal 2009; $1.5 trillion estimated for fiscal 2010).

As I said earlier, the numbers that most concern Democrats are the declining poll numbers. The president’s approval rating is now below 50% and reached a new low Saturday in the Rasmussen daily tracking poll.

Several incumbent Democrats are now trailing in their re-election runs in 2010, including Bennett in Colorado, Dodd in Connecticut, Reid in Nevada, Lincoln in Arkansas, Specter in Pennsylvania, as well as in the Democratic-held Delaware open seat. The open seat in Illinois is also very competitive. The number of retiring Democrats and vulnerable Democrats in the House grows each week.

Approval ratings for Congress are disastrous, and Democrats are the party in control of both branches of Congress. Finally, and most worrisome, are the numbers on health care reform. The disapproval ratings have soared in recent weeks, and not just the Fox News [oll.

Rasmussen has support for the reform bill at 41% and opposition at 51%. CNN/Opinion Dynamics had a shocking survey showing 36% support and 61% opposition, a more negative result than the Fox poll with 34% support and 57% opposition. Some Democrats have to wonder whether they will gain politically from pushing through a complex package of reforms with greatly increased federal spending, little evidence of any cost savings, and all the votes coming from their own party when 60% or more of the voting public think it is a bad idea.

The failure of the Democrats, if it occurs, will not be because they could not entice a few wavering moderate Democratic senators. Health care reform went off the rails when the Pelosi/George Miller/Jan Schakowsky wing of the Democratic party was given control over drafting the bill. The result was predictable. No GOP input was welcome. Tort reform, allowing insurance companies to sell across state lines, reducing the many mandates that drive up the cost of insurance, and encouraging the sale of more catastrophic insurance policies (much less expensive for the young and healthier among the uninsured) were all cost-saving ideas that never had a chance of inclusion in any of the bills.

Instead the Democrats have made the bad things worse -- such as interfering with insurance underwriting policies so that age becomes much less a factor in premium cost. This will result in one more enormous wealth transfer from younger Americans to older Americans.

The design of this bill was purposeful: Create a new comprehensive middle class entitlement that would be impossible to reverse and would grow over time. Use smoke and mirrors to pay for it while hiding the true cost of the measure by starting the benefits five years out in the ten year scoring time frame.

We are likely to see some very erratic behavior by Democratic senators in the next few weeks. The reform effort hangs by a thread, and the party may now suffer politically if it passes -- or if the effort collapses.